• V3-serotyping programme evaluated for HIV-1 variation in the Netherlands and Curacao

      Wolf F de; Akker R van den; Valk M; Bakker M; Goudsmit J; Loon AM van; VIR; UVA/HRL (1995-01-31)
      To obtain insight into the variation of the HIV-1 V3 neutralization domain of variants circulating in the Netherlands, 126 Dutch, 70 Curacao and 45 African serum samples from HIV-1 infected individuals were screened for antibody reactivity to a set of 16 to 17 mer synthetic peptides, representing the central part of the V3-loop of gp120 of HIV-1 variants circulating in the US, Europe and Africa. These peptides were used in an ELISA and antibody reactivity to the peptides was compared to the actual amino acid sequence of viral RNA circulating in a subset of the same serum samples. In conclusion, we found a relatively high genetic and antigenic homogeneity of the V3 gene of HIV infections in the Netherlands and Curacao during the years 1988-1990. Antibody reactivity to synthetic V3 peptides, as well as sequence analysis confirmed the prevalence of B subtype HIV-1 among the Dutch and Curacaon samples and the prevalence of A/D subtypes among the Tanzanian samples. Screening of HIV-1 positive serum samples for genetic typing by using a set of well defined synthetic V3 peptides appeared to be feasible. In combination with molecular analysis (V3 sequencing and/or hetroduplex mobility assay) of this method can be applied to obtain insight in changes in genetic and antigenic variation of HIV-1 in a population: changes within subtype B HIV-1 variants, as well as introduction of other (new) HIV-1 variants can this be surveyed. This is of importance to obtain insight in the (molecular) epidemiology of HIV-1 as well as with respect to the development and the eventual use of an HIV-1 vaccine.
    • V3-serotyping programme evaluated for HIV-1 variation in the Netherlands and Curacao

      Wolf F de; Akker R van den; Valk M; Bakker M; Goudsmit J; Loon AM van; VIR; UVA/HRL (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 1995-01-31)
      Doel van het onderzoek was om inzicht te verkrijgen in de antigene en genetische variatie van het in Nederland en Curacao circulerende humane immunodeficientie virus type 1 (HIV-1). De genetische variatie tussen HIV-1 isolaten is aanzienlijk. De genetische variatie doet zich vooral voor op een vijftal gebieden van het deel van het virale genoom, dat codeert voor het externe envelop eiwit gp120 van HIV-1. Van deze vijf gebieden is het derde variabele domein (V3) gelegen tussen aminozuur-positities 269 en 331 van gp120 het meest uitvoerig bestudeerd. Van de Nederlandse serummonsters reageerde 54.8% specifiek tegen een van de peptiden p108, p109 of p110, welke representatief zijn voor het genotype B. Voor wat betreft de monsters afkomstig uit Curacao werd een vergelijkbaar resultaat gevonden, met dit verschil dat ten opzichte van de Nederlandse monsters een relatief hoge frequentie van serum reactiviteit tegen p110 werd gevonden. Op grond van de serologische reactiviteit in het V3 gebied kan worden geconcludeerd dat in de periode 1988 - 1990 in Nederland en Curacao subtype B HIV-1 varianten het meest prevalent waren. De V3-loop reactiviteit bleek vergelijkbaar met die gemeten in de Amsterdamse cohortstudies onder homoseksuele mannen en druggebruikers. De resultaten van de specifieke antistofreactiviteit werd in het algemeen bevestigd door de resultaten van het V3 sequentie-onderzoek, maar subtiele sequentieverschillen tussen de V3 loop reactiviteit en circulerend viraal V3 werden in een aantal gevallen aangetoond. Aanbevolen wordt in 1995 een tweede survey uit te voeren, te meer daar inmiddels meer bekend is over verschillende subtypen van HIV-1 en recent het zogeheten subtype O is beschreven.
    • Vaardigheidseisen voor veilig toepassen van medische technologie in de ziekenhuiszorg : Een praktijkverkenning

      de Vries CGJCA; Pot JWGA; Koudijs-Siebel EA; Geertsma RE; van Drongelen AW; PRV; V&Z (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2014-03-21)
      In health care, the use of complex medical technology, such as a surgical robot, increases. The safe use of these technologies requires special skills of health care professionals. Therefore, the Dutch Ministry of Health, Welfare and Sports has requested the RIVM to make recommendations for skill requirements that are in line with the activities of the hospitals and professional societies and associations. Findings Results from this study revealed that there is awareness within hospitals and health care professionals for the need for specific skill requirements for the safe use of complex medical technology. There are several initiatives in this area. However, the extent to which this occurs varies per profession and hospital. A uniform approach is missing. Several initiatives are identified, so-called best practices, where skill requirements are established. For instance, a system in which all users of medical equipment are trained and certified. Recommendations This exploratory study provides general recommendations. These recommendations could serve as a starting point for discussion on the need for specific skill requirements for the safe use of medical technology. Safe use of medical technology should play a more prominent role in the safety management systems of hospitals. It is recommended that hospital boards facilitate multidisciplinary collaboration of various health care professionals. The scientific associations can also contribute, for example by explicitly including skill requirements for medical technology in visitations and making the results of the visitations less noncommittal. Furthermore, the refresher courses attended should be better related to the activities performed. It should be investigated whether the best practices are more widely applicable.
    • Vaccinatiegraad en jaarverslag Rijksvaccinatieprogramma Nederland 2016

      van Lier EA; Geraedts JLE; Oomen PJ; Giesbers H; van Vliet JA; Drijfhout IH; Zonnenberg-Hoff IF; de Melker HE; RVP; I&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2017-06-22)
      The RIVM annually describes the developments within the Dutch National Immunisation Programme (NIP), both substantively and organisationally. From this year, the most important events and developments in the field of immunisation coverage have been bundled. Important events In 2016, there were no significant outbreaks of NIP diseases. However, since October 2015, the number of meningococcal disease patients by a different serogroup (W) than the serogroup C which is vaccinated against within the NIP, has risen. Striking was the vigorous debate that was conducted in various media in November 2016 between advocates and opponents of immunisation. Furthermore, the RIVM has made factsheets for professionals as well as the public with information on vaccines against diseases that are available but not included in the NIP. Examples include varicella, herpes zoster and rotavirus (www.rivm.nl/vaccinations). Immunisation coverage The immunisation coverage, i.e. the proportion of newborns, toddlers and schoolchildren who receive vaccinations within the NIP is still high. The immunisation coverage for mumps, measles and rubella (MMR) has declined slightly for a few years. The 95 per cent threshold of the World Health Organization (WHO) needed to eliminate measles is no longer achieved in the Netherlands for the first MMR vaccination. For the second MMR vaccination this has been for longer. Also for other NIP vaccinations there is a slight decrease in participation. The participation in HPV vaccination against cervical cancer has decreased for the first time, from 61 to 53 per cent. A high immunisation coverage ensures that vulnerable and not (yet) vaccinated children are protected against diseases (herd protection). A decreasing immunisation coverage increases the likelihood that diseases such as measles cause outbreaks in the future.
    • Vaccinatiegraad en jaarverslag Rijksvaccinatieprogramma Nederland 2017

      van Lier EA; Geraedts JLE; Oomen PJ; Giesbers H; van Vliet JA; Drijfhout IH; Zonnenberg-Hoff IF; de Melker HE; RVP; EPI (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2018-06-25)
      The RIVM annually describes the developments within the Dutch National Immunisation Programme (NIP), both substantively and organisationally. Attention is paid to the most important events in the past year and the developments in the field of immunisation coverage. Important events In 2017, there were no noticeable outbreaks of diseases which are vaccinated against within the NIP. However, the number of patients with meningococcal W disease has increased further compared to 2015 and 2016. In May 2018, the meningococcal C vaccination at the age of 14 months will therefore be replaced by meningococcal ACWY vaccination. In autumn 2018, this vaccination will also be offered to children born between 1 May 2004 and 31 December 2004. In 2017, the e-learning Backgrounds NIP and the renewed website (https://rijksvaccinatieprogramma.nl) became available. Preparations have also been made for the introduction of the vaccination consultation in which parents can discuss questions about the NIP. Immunisation coverage The immunisation coverage, i.e. the proportion of newborns, toddlers and schoolchildren who receive the vaccinations within the NIP, is still high but has declined slightly in recent years. For the HPV vaccination, the further decrease in the immunisation coverage of 8 percent compared to last year is remarkable. However, there is not only a decline seen in the Netherlands. The main reason not to vaccinate against HPV or to doubt this is concerns about possible side effects of the HPV vaccine. The Health Council will again issue an advice on HPV vaccination in the Netherlands. A high vaccination coverage is important. When many people have been vaccinated against an infectious disease, this disease occurs less frequently (group protection). Vulnerable people and people who have not (yet) been vaccinated are also less likely to get the disease. They are protected, as it were, by the vaccinated group. To maintain this effect, it is important that as many people as possible have been vaccinated.
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland : Verslagjaar 2010

      van Lier EA; Oomen PJ; Zwakhals SLN; Drijfhout IH; de Hoogh PAAM; de Melker HE; EPI; cib (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2010-09-06)
      Just like previous years, at national level, the average participation for all vaccinations included in the National Immunization Programme was considerably above the lower limit of 90% for 2010. For the MMR vaccination the lower limit used by the WHO is with 95% somewhat higher to be able to eliminate measles worldwide. This lower limit was reached for the first MMR vaccination (babies) but not for the second MMR vaccination (9-year olds). Therefore, an outbreak of measles in the Netherlands is not impossible. The above results are stated in a report by the National Institute for Public Health and the Environment (RIVM) on the vaccination coverage in the Netherlands in 2010. Included in the report is data on babies born in 2007, young children born in 2004 and schoolchildren born in 1999. For babies, the participation for the MMR, Hib and meningococcal C vaccinations was 96%, for the DTaP-IPV vaccination 95% and for the pneumococcal vaccination 94%. The participation for hepatitis B vaccination among children of whom one or both parents was born in a country where hepatitis B occurs frequently has increased further. The hepatitis B vaccination for children of mothers who are carrier of hepatitis B still requires some attention since children who are infected with this virus at a young age have a higher risk of becoming a carrier of this virus and of contracting liver disorders in the long term. Voluntary vaccination in the Netherlands results in a high vaccination coverage. High levels of immunization are not only necessary in order to protect as many people individually as possible but also to protect the population as a whole (group immunity) against outbreaks of infectious diseases. Continuous efforts need to be made by all parties involved in the National Immunization Programme (NIP) to ensure that children in the Netherlands are vaccinated on time and in full.
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland : Verslagjaar 2011

      van Lier EA; Oomen PJ; Giesbers H; Drijfhout IH; de Hoogh PAAM; de Melker HE; EPI; cib (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2011-06-16)
      Just like previous years, at national level, the average participation for all vaccinations (except HPV) included in the National Immunization Programme was considerably above the Dutch lower limit of 90% for 2011. The lower limit of 95%, used by the WHO for MMR vaccination, was not yet reached for schoolchildren. The above results are stated in a report by the National Institute for Public Health and the Environment (RIVM) on the vaccination coverage in the Netherlands in 2011. Included in the report is data on babies born in 2008, young children born in 2005, schoolchildren born in 2000 and adolescent girls born in 1993-1997. For babies, the participation for the MMR, Hib and meningococcal C vaccination was 96%, for the DTaP-IPV and pneumococcal vaccination 95%. The participation for the first hepatitis B vaccination for children of mothers who are carrier of hepatitis B increased further to 99%. Besides, the participation among schoolchildren for DT-IPV and MMR was with 92% somewhat lower than in the previous year of report. The interim immunization coverage for adolescent girls born in 1997, who were offered HPV vaccination within the NIP for the first time, was 52,5%. Within the HPV catch-up campaign (adolescent girls born in 1993-1996) a participation of 52,3% was reached. Voluntary vaccination in the Netherlands results in a high vaccination coverage. High levels of immunization are necessary in order to protect as many people individually as possible and for most target diseases in the NIP also to protect the population as a whole (group immunity) against outbreaks. Continuous efforts need to be made by all parties involved in the National Immunization Programme (NIP) to ensure that children in the Netherlands are vaccinated on time and in full.
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland : Verslagjaar 2012

      van Lier EA; Oomen PJ; Giesbers H; Drijfhout IH; de Hoogh PAAM; de Melker HE; EPI; cib (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-05-10)
      Just like previous years, at national level for year of report 2012, the average participation for all vaccinations included in the National Immunization Programme (NIP) is with 92 to 99% high. Exception is the participation for HPV vaccination against cervical cancer (56%). The lower limit of 95% for the MMR vaccination was not yet reached for schoolchildren (the second MMR vaccination for 9 year olds; 93%). However, babies do reach this lower limit. The World Health Organization (WHO) has determined this lower limit to be able to eliminate measles worldwide. The above results are stated in a report by the National Institute for Public Health and the Environment (RIVM) on the vaccination coverage in the Netherlands in year of report 2012. Included in the report is data on babies born in 2009, young children born in 2006, schoolchildren born in 2001 and adolescent girls born in 1997. Participation per vaccination: For babies, the participation for the MMR, Hib and meningococcal C vaccination was 96%, for the DTaP-IPV and pneumococcal vaccination 95%. The participation among schoolchildren for DT-IPV and MMR was again somewhat higher than in the year of report 2011 (93% versus 92%). The immunization coverage for adolescent girls born in 1997, who were offered HPV vaccination within the NIP for the first time, was 56%. Vaccination on time and in full important: With voluntary vaccination, a high vaccination coverage is reached in the Netherlands. High levels of immunization are necessary in order to protect as many people individually as possible. For most target diseases in the NIP it is also important to protect the population as a whole against outbreaks (group immunity). To ensure that children in the Netherlands are vaccinated on time and in full, continuous efforts need to be made by all parties involved in the National Immunization Programme (NIP).
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland : Verslagjaar 2013

      van Lier EA; Oomen PJ; Mulder M; Conyn-van Spaendonck MAE; Drijfhout IH; de Hoogh PAAM; de Melker HE; RVP; I&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2013-06-13)
      Just like previous years, at national level for year of report 2013, the average participation for all vaccinations included in the National Immunisation Programme (NIP) is high with 92 to 99%. Exception is the participation for HPV vaccination against cervical cancer, which increased with 2% compared to last year, to 58%. The participation for the pneumococcal vaccination (95%) and the second MMR vaccination for 9-year-olds (93%) increased also slightly compared to last year (both with 0.3%). This latter finding is important because of the aim of the World Health Organization (WHO) to eliminate measles worldwide. Furthermore, there are fewer municipalities with one or more vaccination percentages (HPV and hepatitis B excluded) below the lower limit of 90% (80 municipalities in year of report 2013 versus 90 municipalities in year of report 2012 and 107 municipalities in year of report 2011). In addition, immunisation of premature children deserves special attention. Because their immunisation is less timely, they are at increased risk of diseases against which the NIP offers protection. In 2013 experts from the Caribbean Netherlands and the RIVM will collaborate on further harmonisation of the immunisation programme on these islands with the Dutch NIP. With voluntary vaccination, a high vaccination coverage is reached in the Netherlands. High levels of immunisation are necessary in order to protect as many people individually as possible. For most target diseases in the NIP it is also important to protect the population as a whole against outbreaks. This protection is reached through group immunity.
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland : Verslagjaar 2014

      van Lier EA; Oomen PJ; Giesbers H; Conyn-van Spaendonck MAE; Drijfhout IH; Zonnenberg-Hoff IF; de Melker HE; RVP; I&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2014-07-03)
      Just like previous years, the participation for the different vaccinations included in the National Immunisation Programme (NIP) is with 92 to 99% high in report year 2014. Exception is the HPV vaccination against cervical cancer, for which the participation compared to the previous report year however increased further to 59%. Since August 2011, the RVP is expanded with vaccination against hepatitis B; until then only children at high risk were vaccinated against it. Among the group of infants without high risk 95% received this vaccination. The participation among infants from the Caribbean Netherlands for the DTaPIPV, MMR and pneumococcal vaccination is also high (90-100%). Point of attention remains that participation in the NIP decreases as children get older. The second MMR vaccination for 9-year-olds (92%) does still not reach the required 95% participation. A participation of at least 95% is important because of the aim of the World Health Organization (WHO) to eliminate measles worldwide. Furthermore, it is still important that all children of mothers, who are carrier of hepatitis B virus, receive the first extra vaccination against it timely. Children who are infected with this virus at a young age have a higher risk of becoming a carrier of it. In the long term this virus can cause serious liver disorders. To protect infants effectively against diseases of the NIP, it is important to give vaccinations on time. The proportion of infants that received the first DTaP-IPV vaccination on time, increased further to 88%. Normally, infants who receive at least one vaccination through an anthroposophic child welfare centre are vaccinated less often and less timely. With voluntary vaccination, a high vaccination coverage is reached in the Netherlands. This results in herd immunity, which is needed for most diseases to protect the population as a whole against outbreaks. Currently, a monitoring system is developed to follow the acceptance of the NIP among parents and NIP professionals in the future.
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland : Verslagjaar 2015

      van Lier EA; Oomen PJ; Conyn-van Spaendonck MAE; Drijfhout IH; Zonnenberg-Hoff IF; de Melker HE; RVP; I&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2015-06-22)
      As in previous years, the participation for the different vaccinations included in the National Immunisation Programme (NIP) is with 92 to 99 per cent high in report year 2015. Exception is the HPV vaccination against cervical cancer, for which the participation continued to increase compared to report year 2014 (to 61 per cent). The participation for hepatitis B vaccination for children born in 2012, the first year in which all infants were eligible for hepatitis B vaccination, is 94 per cent. The participation among infants from the Caribbean Netherlands for the DTaP-IPV, MMR and pneumococcal vaccination is also high. The participation for MMR vaccination for 9-year-olds (93 per cent) is identical to participation for DTaP vaccination this time; usually participation for MMR vaccination is slightly lower. This is an improvement but the required participation is not reached. A participation of at least 95 per cent is important because of the aim of the World Health Organization (WHO) to eliminate measles worldwide. Such a high vaccination is important to protect the general population against outbreaks (herd immunity). To protect infants effectively against diseases of the NIP it is also important to give vaccinations on time. The proportion of infants that received the first DTaP-IPV vaccination on time, i.e. before they are 10 weeks old, increased further to 89 per cent. In addition, the timely and full participation in the primary DTaP-IPV series (the first three vaccinations) improved from 60 per cent for children born in 2007 to 69 per cent for children born in 2012. With voluntary vaccination, a high vaccination coverage is reached in the Netherlands.
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland : Verslagjaar 2016

      van Lier EA; Oomen PJ; Giesbers H; van Vliet JA; Drijfhout IH; Zonnenberg-Hoff IF; de Melker HE; RVP; I&V (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2016-06-30)
      As in previous years, the immunisation coverage or the participation for the different vaccinations included in the National Immunisation Programme (NIP) is with 92 to 99 per cent high in report year 2016. However, the participation for most vaccinations declined about 0.5 per cent. For infants, this decline is seen for the second consecutive year. In the past, such fluctuations were observed before at regional level, but they are now for the first time found in the whole country. An explanation is lacking. The participation for the HPV vaccination against cervical cancer has remained unchanged at 61 per cent. Participation among infants in the Caribbean Netherlands has also remained unchanged with 92 to 100 per cent. New key figure Starting this year, the situation on the different policy areas of the Ministry of Health, Welfare and Sport appears in so-called key figures to monitor and justify the policy. For the vaccination coverage, a key figure has also been established, namely the percentage of all children who received all NIP vaccinations at the day they reach their second birthday. For children who were born in 2013, this is 93 per cent. Hepatitis B risk groups From 2012 onwards, not only children at risk but all children are offered hepatitis B vaccination. However, it appears that just the children of whom at least one parent is born in a country where hepatitis B is common, do not always receive the vaccination. In addition, the hepatitis B control research on the effectiveness of the vaccine among children of mothers who are carriers of hepatitis B virus, is not always conducted. Especially for these two risk groups, protection against hepatitis B is important. With voluntary vaccination, a high vaccination coverage is reached in the Netherlands. This is evident from the national registration system for the vaccinations of the RIVM. A high participation in the programme is important to prevent infectious diseases coming back again. A high vaccination coverage also ensures that vulnerable not (yet) vaccinated children are protected against diseases (herd immunity).
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland. Verslagjaar 2009

      van Lier EA; Oomen PJ; Oostenbrug MWM; Zwakhals SLN; Drijfhout IH; de Hoogh PAAM; de Melker HE; EPI (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2009-06-15)
      At national level, the average vaccination percentages for all vaccinations included in the National Immunization Programme were considerably above the lower limit of 90 percent for 2009. In spite of the extra vaccination against pneumococcal disease, the average vaccination percentages were in general somewhat higher than in 2008. For babies, the percentage for MMR, Hib and meningococcal C disease vaccinations was 96 percent, for DTaP-IPV, 95 percent and for pneumococcal disease, 94 percent. The vaccination coverage for hepatitis B does still require some attention because it is relatively low. Children who are infected with this virus at a young age have a higher risk of becoming a carrier of this virus and of contracting liver disorders at long term. This vaccination is only offered to children in risk groups. The above results are stated in a report by the National Institute for Public Health and the Environment (RIVM) on the vaccination coverage in the Netherlands in 2009. Included in the report is data on babies born in 2006, young children born in 2003 and school-aged children born in 1998. Voluntary vaccination in the Netherlands results in a high vaccination coverage. High levels of immunization are necessary in order to protect the population (group immunity) against outbreaks of infectious diseases. Continuous efforts need to be made by all parties involved in the National Immunization Programme (NIP) to ensure that children in the Netherlands are vaccinated on time and in full. Furthermore, it is important to know what the attitude of the Dutch population towards vaccination is. The low coverage for the vaccination campaign against cervical cancer (HPV) - even though this concerns another age-group - shows that the coverage for new vaccinations is not naturally high.
    • Vaccinatiegraad Rijksvaccinatieprogramma Nederland; verslagjaar 2006-2008

      van Lier EA; Oomen PJ; Oostenbrug MWM; Zwakhals SLN; Drijfhout IH; de Hoogh PAAM; de Melker HE; EPI (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-05-16)
      Vaccination coverage in the Netherlands is high. High levels of immunization are necessary in order to protect the population against outbreaks of infectious diseases (group immunity). Continuous efforts need to be made by all parties involved in the National Immunization Programme (NIP) to ensure that the Dutch population is sufficiently protected, both now and in the future. One important point is that children need to be vaccinated according to schedule, on time and in full, in accordance with the NIP guidelines. In general, vaccination coverage for toddlers and school-aged children requires extra attention. This applies in particular to the second MMR vaccination and to the vaccination of children whose parents were born in a country where the incidence of hepatitis B is higher than average. The report shows that the coverage for these vaccinations, included in the report for the first time, is relatively low. Between 2006 and 2008, a slightly lower vaccination coverage was recorded compared to other years, particularly for toddlers and school-aged children. The difference is largely due to a new method of measuring the vaccination coverage, which was introduced in 2006. The data now give more accurate information on whether the vaccinations meet the NIP guidelines, including when the vaccinations were given. This report presents the information on vaccination coverage in the Netherlands from 2006 to 2008. Included in the report is data on babies born between 2003 and 2005, toddlers born between 2000 and 2002 and school-aged children born between 1995 and 1997. At national level, in 2008 the average vaccination percentages for all vaccinations were above the lower limit of 90 percent for: babies born in 2005, toddlers born in 2002 and school-aged children born in 1997. More detailed information on the vaccination percentages per province and municipality is given in the report. The vaccination coverage is particularly low in areas where a relatively high number of people refuse vaccination on religious grounds.
    • Vaccinatietoestand Nederland per 1 januari 2004

      Abbink F; Oomen PJ; Zwakhals SLN; Melker HE de; Ambler-Huiskes A; Landelijke Vereniging van Entadministraties; IGZ; CIE (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2005-06-07)
      In dit rapport treft u de cijfers aan van de vaccinatietoestand in Nederland per 1 januari 2004 voor zuigelingen, kleuters (4-jarigen) en schoolkinderen (9-jarigen) van de cohorten 2001, 1998 en 1993.De vaccinatiegraad in Nederland is al jaren zeer goed te noemen. Het afgelopen verslagjaar is de vaccinatiegraad voor alle vaccinaties - behalve voor DTP schoolkinderen - toegenomen. De lichte daling van de vaccinatiegraad bij zuigelingen sinds 1996 heeft zich hersteld. Met name de meest kwetsbare groep zuigelingen (< 6 maanden) is dit jaar nog beter beschermd met entpercentages voor D(K)TP en Hib >97%. De landelijke entpercentages zijn voor het eerst alle boven de 95% en voldoen hiermee ruim aan de WHO-normen. Ook op provinciaal en gemeentelijk niveau is het beeld over het algemeen gunstig. Alle provincies voldoen aan de norm van minimaal 90%, bovendien komen op gemeentelijk niveau vaccinatiepercentages <60% niet meer voor. De gebieden met onvoldoende vaccinatiepercentages concentreren zich weer voornamelijk in de 'Bible belt'.Toch blijft waakzaamheid geboden omdat inmiddels duidelijk is dat het met de vaccinatiegraad van de geboortecohorten vanaf eind 2003 minder goed gesteld is door de enorme media-aandacht die er geweest is met name rond het nieuw in te voeren acellulair kinkhoestvaccin. Continue aandacht en niet aflatende inzet van alle betrokkenen bij het RVP zullen nodig zijn om de jeugd ook in de toekomst afdoende te kunnen beschermen. Van zeer groot belang hierbij is het voorlichten van ouders en andere betrokkenen over nut en noodzaak van (een correcte uitvoering van) het RVP.
    • Vaccinatietoestand Nederland per 1 januari 2005

      Abbink F; Oomen PJ; Zwakhals SLN; Melker HE de; Ambler-Huiskes A; Landelijke Vereniging van Entadministraties; Inspectie voor de Gezondheidszorg; CIE (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2006-08-03)
      Voor alle vaccinaties die zijn opgenomen in het Rijksvaccinatieprogramma (RVP) is het afgelopen verslagjaar de vaccinatiegraad op landelijk niveau toegenomen. De gemiddelde vaccinatiepercentages zijn hoger dan 95% en voldoen hiermee ruim aan de normen van de World Health Organisation (WHO). Dit blijkt uit een jaarlijkse evaluatie door het RIVM. Nederland heeft al jaren een hoge vaccinatiegraad. De evaluatie van 2005 richt zich op zuigelingen, kleuters en schoolkinderen van de geboortejaren 2002, 1999 en 1994. De meest kwetsbare groep zuigelingen (< 6 maanden) is dit jaar nog beter beschermd tegen D(K)TP (difterie, kinkhoest, tetanus en polio) en Hib (Haemophilus influenzae type b). De vaccinatiepercentages zijn nog nooit zo hoog geweest; ze liggen ruim boven de 97%. Ook de vaccinatiepercentages voor het BMR-vaccin (Bof, Mazelen en Rode hond) bij zowel zuigelingen als schoolkinderen en het DTP-vaccin bij kleuters zijn hoger dan ooit. Ook op provinciaal en gemeentelijk niveau is het beeld over het algemeen gunstig. Alleen Zeeland en Flevoland rapporteren vaccinatiepercentages onder de norm van 90%. De gebieden met onvoldoende vaccinatiepercentages concentreren zich weer voornamelijk in de zone die ook wel 'Bible belt' wordt genoemd. Continue aandacht blijft noodzakelijk om de jeugd ook in de toekomst voldoende te kunnen beschermen. In Nederland is nog altijd een grote groep niet-gevaccineerde personen aanwezig en de dreiging van import van ziektes als mazelen en polio is groot.
    • Vaccinatietoestand Nederland per 1 januari 2004

      Abbink F; Oomen PJ; Zwakhals SLN; de Melker HE; Ambler-Huiskes A; CIE (Rijksinstituut voor Volksgezondheid en Milieu RIVMLandelijke Vereniging van EntadministratiesIGZ, 2005-06-07)
      This report describes the progress of the National Immunization Programme (NIP) in the Netherlands. Immunization coverage figures as at 1 january 2004 are presented for all vaccines used in the NIP for agecohorts born in 1993, 1998 and 2001.For years national immunization coverage in the Netherlands has been excellent. For 2004 national coverage levels for all vaccines used increased and exceeded 95% for the first time. The slow but steady decrease in coverage for infants reported since 1996 has been restored to a level of coverage exceeding 97%.Although high national immunization coverage can mask variations within country, regional and municipal immunization coverage also improved over the past year. All provinces reported over 90% immunization coverage for all vaccines used and municipal immunization coverage levels below 60%, previously observed each year, were not reported.Areas with low immunization coverage are - once again - concentrated in the so called 'Bible-belt' where groups of orthodox reformed people live who refuse vaccination for religious reasons.In spite of the progress made for the past year under review, joint efforts are still needed to obtain and sustain high immunization coverage. Particularly because it is already known that immunization coverage for the birthcohorts following 2001 was negatively affected by the massive attention paid to the introduction of the new DTaP-IPV-Hib vaccine by the media. Continuous attention and joined efforts of all parties engaged in the NIP will be needed to ensure that the population of the Netherlands is well educated and motivated to have their children immunized.
    • Vaccinatietoestand Nederland per 1 januari 2005

      Abbink F; Oomen PJ; Zwakhals SLN; de Melker HE; Ambler-Huiskes A; CIE (Rijksinstituut voor Volksgezondheid en Milieu RIVMLandelijke Vereniging van EntadministratiesInspectie voor de Gezondheidszorg, 2006-08-03)
      In 2005 national coverage levels for all vaccines used in the Netherlands showed a further increase as compared to 2004. Immunization coverage figures exceed the 95% level and meet the standards provided by the World Health Organisation. The national immunization coverage in the Netherlands has proven, over the years, to be excellent.This report describes the progress made in the Dutch National Immunization Programme (NIP). Immunization coverage figures as at 1 january 2005 are presented for all vaccines in the NIP for age cohorts born in 1994, 1999 and 2002. Vaccination coverage for the most vulnerable group (infants < 6 months of age) showed an increase compared to previous years, largely exceeding the 97% level. Vaccination coverage levels for infants (DTP-IPV and Hib) were reported to be higher than ever before. The same result was seen in MMR vaccination coverage levels for both infants and 9-year olds, and in DPT vaccination coverage levels for 4-year olds. Although high national immunization coverage can mask variations within country, regional and municipal immunization coverage figures improved again. Almost all provinces reported over 90% immunization coverage for all vaccines used. Exceptions were Zeeland and Flevoland. Areas with low immunization coverage are - once again - concentrated in the so-called 'Bible-belt' where groups of orthodox reformed people live who refuse vaccination for religious reasons. Continuous attention and joint efforts of all parties engaged in the NIP will be needed to ensure that the population of the Netherlands is well informed on immunization and motivated to have their children immunized. Recent outbreaks of Measles and Rubella show the existence of a large group of unvaccinated people in the Netherlands. Importing diseases like measles and polio remains a risk.
    • Vaccine-induced antibody responses as parameters of the influence of endogenous and environmental factors

      Loveren H van; Amsterdam JGC van; Vandebriel RJ; Kimman TG; Rumke HC; Steerenberg PS; Vos JG; LPI; LEO; LIO; LVO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2000-06-30)
      De beste manier om in het proefdier effecten op het immuunsysteem vast te stellen, is de bestudering van effecten op antigeen specifieke immuunresponsen, bijvoorbeeld na sensibilisatie met T-cel afhankelijke antigenen. Waarschijnlijk gaat dit ook op voor het testen van effecten in de bevolking. Om die reden is gesuggereerd antilichaam responsen na vaccinatie als uitleessysteem te gebruiken. Naast omgevingsfactoren worden vaccinatieresponsen beinvloed door andere factoren. Een factor die van grote invloed is, is het vaccin zelf en de procedure om te vaccineren. Daarnaast is de intrinsieke capaciteit van de recipient om te reageren van belang; dit wordt bepaald door genetische factoren en de leeftijd. Daarnaast zijn psychologische stress, voeding en ziekte (waaronder infectieziekten) van belang. In het rapport wordt een overzicht gegeven van de literatuur over invloeden op vaccinatieresponsen. Het blijkt dat voor wat betreft exogene factoren er duidelijk aanwijzingen zijn dat roken, voeding, psychologische stress en bepaalde infectieziekten een effect op vaccinatieresponsen hebben, maar dat het moeilijk is vast te stellen wat het relatieve belang ervan is. Bekend is dat genetische factoren sommige individuen voor sommige vaccins ongevoelig maken. Een algemene conclusie is dat in epidemiologische studies, waarbij nadelige effecten van blootstelling aan omgevingsfactoren op het immuunsysteem worden bestudeerd, en waarbij vaccinatietiters worden gebruikt, die additionele factoren in aamerking genomen dienen te worden. Indien voor deze additionele factoren wordt gecorrigeerd, kan een studie waarbij associatie wordt gevonden van een verminderde vaccinatierespons met blootstelling aan een omgevingsfactor indiceren dat het immuunsysteem suboptimaal functioneert. Het is niet waarschijnlijk dat een dergelijk effect zal inhouden dat bescherming waarvoor de vaccinatie was bedoeld wordt aangetast. Alleen in die gevallen waarbij individuen een matige respons vertonen, zouden nadelige effecten wellicht tot een klinische significante afname van bescherming kunnen leiden. Meer in het algemeen zou kunnen worden vastgesteld dat een afname in vaccinatierespons aan kan geven dat er een verminderde weerstand zou kunnen bestaan tegen pathogenen waartegen niet is gevaccineerd.
    • Vaccine-induced antibody responses as parameters of the influence of endogenous and environmental factors

      van Loveren H; van Amsterdam JGC; Vandebriel RJ; Kimman TG; Rumke HC; Steerenberg PS; Vos JG; LPI; LEO; LIO; LVO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2000-06-30)
      The most adequate way to assess effects of environmental exposures on the immune system using laboratory animals is to study effects on antigen-specific immune responses, such as after sensitization to T cell dependent antigens. Most likely, this also applies for testing effects in the human population. For this reason it has been suggested to utilize antibody responses to vaccination as readout. In addition to environmental factors, vaccination responses may be influenced by a variety of other factors. One factor is the vaccine itself, and the vaccination procedure. In addition, the intrinsic capacity of the recipient to respond to a vaccine is important, which is determined by genetic factors and age. Also psychological stress, nutrition, and (infectious) diseases are likely to have an impact. The present report reviews the literature. It appears that with regard to exogenous factors, there is good evidence that smoking, food, psychological stress, and certain infectious diseases have an impact on vaccination titers, although it is difficult to state the magnitude. Genetic factors render certain individuals non-responsive to vaccination. In general, the conclusion is that in epidemiological studies of adverse effects of exposure to agents in the environment, in which vaccination titers are used, these additional factors need to be taken into consideration. Provided that these factors are corrected for, a study that shows an association of exposure to a given agent with diminished vaccination responses may indicate a suboptimal function of the immune system, and clinically relevant diminished immune response. It is quite unlikely that environmental exposures that affect responses to vaccination, may in fact abrogate protection to the specific pathogen for which vaccination was meant. Only in those cases, where individuals have a poor response to the vaccine, exogenous factors may perhaps have a clinically significant influence on resistance to the specific pathogen for which the vaccination was meant. An exposure-associated inhibition of a vaccination response may, however, signify a decreased host resistance to pathogens against which no vaccination had been performed.<br>